A novel Doppler echocardiography scoring index (ESI ≥1.0) improved the prediction of severe pulmonary hypertension in chronic lung disease compared to PASP alone (IDI 11.3%; 95% CI 4.5%-18.2%; P=0.001).
Cross-Sectional (n=107)
Does a novel Doppler echocardiography scoring index (ESI) improve the prediction of severe pulmonary hypertension in patients with chronic lung disease compared to PASP alone?
A novel Doppler echocardiography scoring index significantly improves the noninvasive prediction of severe pulmonary hypertension in patients with chronic lung disease.
Effect estimate: IDI 11.3% (95% CI 4.5%-18.2%)
Absolute Event Rate: 91.1% vs 80.4%
p-value: p=0.001
Background: Severe pulmonary hypertension (PH) resulting from a chronic lung disease (CLD) (severe CLD-PH) requires more aggressive treatment due to its increased mortality compared with mild PH. Therefore, we developed a Doppler echocardiography scoring index (ESI) to predict severe CLD-PH. Methods: A derivation cohort of 107 patients with CLD who underwent echocardiography was classified into two groups, the normal/mild PH group and the severe PH group, based on the right heart catheterization. Meanwhile, we designed the ESI by multivariate logistic regression to validate the predicted outcomes. The ESI was calculated using the following formula: ESI = ESI RVEDTD + ESI PASP + ESI PAd - ESI TAPSE . Additionally, the ESI was weighted by +2 points for right ventricular end-diastolic transverse dimension ≥3.8 cm or pulmonary artery diameter ≥2.7 cm, +3 points for systolic pulmonary artery pressure (PASP) ≥61 mmHg, and -3 points for tricuspid annular plane systolic excursion ≥1.65 cm. Results: In the derivation cohort, PASP ≥61 mmHg estimated by echocardiography exhibited 80.4% sensitivity and 84.3% specificity with area under receiver-operating characteristic curve of 0.823 (95% CI: 0.797–0.942, P <0.0001). Compared with PASP, ESI ≥1.0 exhibited 91.1% sensitivity and 80.4% specificity, resulting in a net improvement in model performance with a change in the c-statistic from 0.823 to 0.937 and an integrated discrimination improvement of 11.3% (95% CI: 4.5%–18.2%, P =0.001). The ESI was applied to the validation cohort, resulting in 84.2% sensitivity and 81.3% specificity with 82.9% accuracy. Conclusion: The ESI showed high capacity for predicting severe CLD-PH, further implying the value of noninvasive examinations in clinic. Keywords: pulmonary hypertension, echocardiography, hemodynamics, right heart catheterization, chronic lung disease
Jiang et al. (Thu,) conducted a cross-sectional in Severe pulmonary hypertension due to chronic lung diseases (n=107). Doppler echocardiography scoring index (ESI) vs. Systolic pulmonary artery pressure (PASP) was evaluated on Prediction of severe CLD-PH (sensitivity) (IDI 11.3%, 95% CI 4.5%-18.2%, p=0.001). A novel Doppler echocardiography scoring index (ESI ≥1.0) improved the prediction of severe pulmonary hypertension in chronic lung disease compared to PASP alone (IDI 11.3%; 95% CI 4.5%-18.2%; P=0.001).
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